POS0733 DISCORDANCE BETWEEN PATIENT GLOBAL ASSESSMENT AND PHYSICIAN GLOBAL ASSESSMENT OF DISEASE ACTIVITY IN THE MODERATE TO SEVERE SYSTEMIC LUPUS ERYTHEMATOSUS PROSPECTIVE OBSERVATIONAL COHORT STUDY (SPOCS)
Authors: L. Arnaud, R. Furie, E. F. Morand, C. Peschken, M. Aringer, E. Rapsomaniki, J. Hedberg, J. Knagenhjelm, C. Seo, T. Grünfeld Eén, B. Desta, A. Sorrentino, R. Tummala, H. Stirnadel-Farrant
Journal: Annals of the Rheumatic Diseases (2022)

Background Emphasis in clinical research and care has been placed on the need to include evaluations that reflect the perspectives of both patients and physicians. Objectives The goal of this study was to analyze patient and physician assessments and to determine characteristics associated with concordance and discordance of these assessments. Methods Baseline data of patients with moderate to severe SLE enrolled in the Systemic Lupus Erythematosus Prospective Observational Cohort Study (SPOCS) 1 were analyzed. Physician’s Global Assessment (PGA) representing disease activity during the 4-week interval prior to baseline and Patient Global Assessment (PtGA) representing the impact of disease during a 1-month interval prior to baseline were independently scored on visual analogue scales (PGA 0-3; PtGA 0-100). Spearman’s rank (rho) was calculated to assess their correlation. A difference between PGA and PtGA scores ≥25 points defined discordance (after rescaling PGA to 0–100). 2 Baseline characteristics associated with concordance and discordance were assessed. Results 827 patients were included in this analysis. At baseline, the mean PGA score was 1.5 (SD 0.6, n=824), and the mean PtGA score was 51.1 (SD 25.5, n=790). The correlation between PGA and PtGA was low (rho=0.19, P &lt;0.001, n=787) (Figure 1). PGA and PtGA scores were discordant in 301 (38%) of patients. Among those patients exceeding the threshold defining discordance, 152 (19%) had higher PGA scores than PtGA scores, and 149 (19%) had higher PtGA scores than PGA scores. The subgroup of PGA-higher discordant patients had higher mean SLEDAI-2K scores, greater serological activity, and more frequent type 1 interferon gene signature positivity, whereas PtGA-higher discordant patients were more likely to be using analgesics and/or anti-depressants, had higher mean BMI and were less likely to be employed (Table 1). Table 1. Characteristics associated with PGA and PtGA scores a Concordant (N=486) PGA higher (N=152) PtGA higher (N=149) P-value-1 b P-value-2 b Age, years 45.5 (13.7) 42.7 (14.4) 46.4 (14.0) 0.022 0.043 Race , White 326 (71%) 96 (66%) 94 (69%) 0.192 0.360 BMI, kg/m 2 27.6 (7.2) 25.6 (5.4) 27.2 (6.4) 0.032 0.011 Employed 249 (51%) 80 (53%) 51 (34%) 0.001 0.001 SLEDAI-2K total score 10.0 (4.8) 10.8 (5.1) 8.2 (3.0) &lt;0.001 &lt;0.001 Positive ANA/anti-dsDNA 436 (90%) 143 (94%) 127 (85%) 0.012 0.041 Low Complement (C3 or C4 ) 132 (46%) 58 (60%) 41 (43%) 0.014 0.026 High IFNGS 313 (71%) 101 (78%) 89 (64%) 0.014 0.049 ≥1 mild flare 115 (24%) 20 (13%) 45 (30%) &lt;0.001 0.001 ≥1 moderate flare 88 (18%) 37 (24%) 23 (16%) 0.057 0.120 ≥1 severe flare 39 (8%) 11 (7%) 15 (10%) 0.372 0.628 OCS daily dose 0.052 0.129 No OCS 214 (44%) 57 (38%) 62 (42%) &gt;0–7.5 mg 139 (29%) 38 (25%) 52 (35%) &gt;7.5–15 mg 75 (15%) 37 (25%) 18 (12%) &gt;15 mg 57 (12%) 19 (13%) 17 (11%) Immunosuppressants 271 (56%) 80 (53%) 75 (50%) 0.690 0.467 Biologics 106 (22%) 25 (16%) 19 (13%) 0.364 0.032 Analgesics 152 (31%) 22 (14%) 46 (31%) &lt;0.001 &lt;0.001 Antidepressants 123 (25%) 31 (20%) 52 (35%) 0.005 0.013 a Mean (SD) for continuous, n (%) for nominal variables. Missing data was &lt;10% of patients for the variables displayed. Denominators exclude missing data. b P -value-1 compares PGA higher vs PtGA higher. P -value-2 compares all 3 groups. Based on the chi-squared test for categorical variables and t-test or ANOVA for continuous variables. IFNGS, type 1 interferon gene signature; OCS, oral corticosteroid; PGA, physician global assessment; PtGA, patient global assessment Conclusion Low correlation between PGA and PtGA suggests both should be used to acquire a broad perspective of the impact of disease on the overall health of patients. Different baseline characteristics were associated with the PGA-higher compared to the PtGA-higher discordant subgroups. References [1]Hammond ER, et al. BMJ Open. 2020;10:e036563. [2]Challa DNV, et al. Rheumatol Ther. 2017;4:201–8. Acknowledgements Editing assistance by Rebecca S. Jones, PhD (Fishawack). This study was sponsored by AstraZeneca. Disclosure of Interests Laurent Arnaud Speakers bureau: AstraZeneca, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Richard Furie Speakers bureau: AstraZeneca, Genentech, Consultant of: AstraZeneca, Grant/research support from: AstraZeneca, Eric F. Morand Speakers bureau: GSK, Novartis, Paid instructor for: AstraZeneca, Biogen, Eli Lilly, Consultant of: AstraZeneca, Biogen, Bristol Myers Squibb, Eli Lilly, EMD Serono, Genentech, GSK, Janssen, Servier, Grant/research support from: Abbvie, AstraZeneca, Bristol Myers Squibb, GSK, Janssen, Christine Peschken Consultant of: AstraZeneca, GSK, Grant/research support from: AstraZeneca, Martin Aringer Speakers bureau: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Chugai, HEXAL, Lilly, MSD, Mylan, Novartis, Roche, Sanofi, UCB, Consultant of: AbbVie, AstraZeneca, BMS, Boehringer Ingelheim, Galapagos, GSK, Pfizer, Roche, Sanofi, Eleni Rapsomaniki Employee of: AstraZeneca, Jonatan Hedberg Shareholder of: AstraZeneca, Employee of: AstraZeneca, Jacob Knagenhjelm Shareholder of: AstraZeneca, Employee of: AstraZeneca, Caroline Seo Shareholder of: AstraZeneca, Employee of: AstraZeneca, Tina Grünfeld Eén Shareholder of: AstraZeneca, Employee of: AstraZeneca, Barnabas Desta Shareholder of: AstraZeneca, Employee of: AstraZeneca, Alessandro Sorrentino Shareholder of: Galapagov, Abbott LAboratories, Gilead Sciences, Moderna, Employee of: Janssen, Sanofi, AstraZeneca, Raj Tummala Shareholder of: AstraZeneca, Employee of: AstraZeneca, Heide Stirnadel-Farrant Shareholder of: AstraZeneca, GSK, Employee of: AstraZeneca